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Anabolic androgenic steroids (AAS) are a class of hormones that are used for hormonal replacement therapy in cases of male hypogonadism and for a few other medical conditions, mainly anemias, as well as for the female-to-male transition process. At the same time, AAS are widely abused for their muscle-building and strength-increasing properties. Among their side effects, androgens can exert a toxic effect on the liver, causing hepatotoxicity, but they can also induce hepatocyte proliferation and malignant transformation. Hepatocellular adenoma (HCA) and hepatocellular carcinoma (HCC) are two primary liver lesions that have been described as potentially related to AAS. This review provides an up-to-date analysis of how androgens can induce liver carcinogenesis and a comprehensive overview on the available data in the literature about AAS and primary liver tumors.

Anabolic androgenic steroids (AAS) are a class of hormones that are used for hormonal replacement therapy in cases of male hypogonadism and for a few other medical conditions, mainly anemias, as well as for the female-to-male transition process. At the same time, AAS are widely abused for their muscle-building and strength-increasing properties. Among their side effects, androgens can exert a toxic effect on the liver, causing hepatotoxicity, but they can also induce hepatocyte proliferation and malignant transformation. Hepatocellular adenoma (HCA) and hepatocellular carcinoma (HCC) are two primary liver lesions that have been described as potentially related to AAS. This review provides an up-to-date analysis of how androgens can induce liver carcinogenesis and a comprehensive overview on the available data in the literature about AAS and primary liver tumors. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate liver transplantation (LT) effectiveness for liver-originated malignancies, focusing on hepatocellular carcinoma (HCC), at a single center. Methods: Retrospective data review of LT cases between 2006 and 2023. Inclusion criteria: no extrahepatic involvement and liver-originated malignancy. Demographic characteristics, etiology, alpha-fetoprotein (AFP) levels, Milan Criteria compliance, pre-transplant treatments, complications, recurrence, and mortality were analyzed. Results: Fourteen liver-originated tumors underwent LT, half of which were from deceased donors. Hepatitis B virus was the common etiology (71%). The median AFP level was 4 ng/mL. Fifty percent received pre-transplant therapy. Patient survival rates at 1, 3, and 5 years: 72%, 72%, 68% respectively. The recurrence-free survival rates for the same years were 93%. Conclusion: LT, including living donor LT, is effective for liver-originated tumors, especially HCC. Encouraging survival rates align with the Milan and University of California, San Francisco Criteria. Despite limitations, ongoing research is vital for LT’s role in liver cancer management, considering tumor size, positron emission tomography/computed tomography, grade, and AFP levels for candidate selection beyond the current criteria.

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As transplant medicine has evolved in recent decades so too have the indications for liver transplantation (LT). Active or suspected malignancy has stopped being considered as a contraindication for organ transplantation, and nowadays LT plays a major role in the treatment strategies of liver tumors. It offers excellent long-term outcomes for certain patients with hepatocellular carcinoma (HCC) and carefully selected patients with cholangiocarcinoma (CCA), who undergo neoadjuvant chemoradiatotherapy. In certain clinical courses of rare primary liver tumors, hepatic epithelioid haemangio-endothelioma (HEHE) and hepatic adenoma (HA), liver transplantation is also considered the best treatment option. Optimal patient selection has become the key issue to achieve the best possible outcomes and to deal with the alleviating shortage of organs. The recent tendency to incorporate markers of tumor biology into selection criteria, rather than simply focusing on tumor size and number, has led to further extension of indications for LT in patients with liver malignancy. This review article focuses on the current place of liver transplantation in the treatment strategy for patients with primary liver tumors, mainly primary liver cancers. [ABSTRACT FROM AUTHOR]

Resumen: Introducción y objetivos: El cáncer primario de hígado es un problema de salud pública en México y en el mundo. El trasplante hepático (TH) es el tratamiento ideal para el carcinoma hepatocelular (CHC) temprano. El objetivo fue evaluar las características de los pacientes con CHC y colangiocarcinoma (CC) en dos centros e identificar a los candidatos a trasplante. Material y métodos: Estudio retrospectivo, observacional del 2012 al 2018 en el Centro de Hepatología (CH) y el Centro Universitario contra el Cáncer (CUCC). Se confirmó CHC o colangiocarcinoma intrahepático (CCi) en 109 pacientes, a los CHC se les aplicaron clasificaciones de estadiaje, modelos de selección para trasplante y modelo pronóstico de recidiva post-TH. Resultados: De la población total, 93% (n = 102) eran cirróticos. El 86% (n = 94) tuvo CHC (58% CH y 42% CUCC) y 14% (n = 15) CCi (40% CH y 60% CUCC). En los pacientes con CHC del CH predominó Okuda I-II, clasificación de Barcelona Clinic Liver Cancer (BCLC) A-B y niveles < 100 ng/mL de alfafetoproteína (AFP), mientras que en el CUCC predominó Okuda II-III, BCLC C-D y niveles > 1,000 ng/mL de AFP. La mitad de la población del CH con CHC cumplía con los criterios para TH, en cambio, en el CUCC solo lo hizo el 23%. Se valoraron 15 pacientes para TH y, a la fecha, se trasplantaron seis. Conclusiones: La neoplasia primaria de hígado más frecuente fue CHC. Los pacientes del CH presentaron la enfermedad más temprana y una proporción más alta cumplía con los criterios para TH. Solo quienes pertenecían a este centro recibieron un trasplante. Abstract: Introduction and aims: Primary liver cancer is a public health problem in Mexico and the world. Liver transplantation (LT) is the ideal treatment for early hepatocellular carcinoma (HCC). Our aim was to evaluate the characteristics of patients with HCC and cholangiocarcinoma (CC) at two centers and identify transplantation candidates. Materials and methods: A retrospective observational study was conducted at the Hepatology Center (HC) and the University Center Against Cancer (UCAC), within the time frame of 2012-2018. HCC or intrahepatic CC was confirmed in 109 patients. Staging classifications, transplant selection models, and a predictive model for post-LT recurrence were applied to the HCC patients. Results: Of the total population, 93% (n = 102) presented with cirrhosis, 86% (n = 94) had HCC (HC: 58%, UCAC: 42%), and 14% (n = 15) had intrahepatic CC (HC: 40%, UCAC: 60%). Of the HC patients with HCC, Okuda I-II, BCLC A-B, and AFP levels < 100 ng/m predominated, whereas Okuda II-III, BCLC C-D, and AFP levels > 1,000 ng/mL predominated in the UCAC patients. Half of the HC population with HCC met the criteria for LT, in contrast to 23% of the UCAC patients. Fifteen patients were evaluated for LT, and at present, six have undergone transplantation. Conclusions: The most frequent primary liver tumor was HCC. Patients from the HC presented with earlier-stage disease and a high number of them met the criteria for LT. Only patients from the HC underwent transplantation.

BackgroundLiver cancer makes up a huge percentage of cancer mortality worldwide. Irreversible electroporation (IRE) is a relatively new minimally invasive nonthermal ablation technique for tumors that applies short pulses of high frequency electrical energy to irreversibly destabilize cell membrane to induce tumor cell apoptosis.MethodsThis review aims to investigate the studies regarding the use of IRE treatment in liver tumors and metastases to liver. We searched PubMed for all of IRE relevant English language articles published up to September 2016. They included clinical trials, experimental studies, observational studies, and reviews. This review manuscript is nothing with ethics issues and ethical approval is not provided.ResultsIn recent years, increasingly more studies in both preclinical and clinical settings have been conducted to examine the safety and efficacy of this new technique, shedding light on the crucial advantages and disadvantages that IRE possesses. Unlike the current leading thermal ablation techniques, such as radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation, IRE requires shorter ablation time without damaging adjacent important vital structures.ConclusionAlthough IRE has successfully claimed its valuable status in the field of hepatic cancer treatment both preclinical and clinical settings. In order to systemically test and establish its safety and efficacy for clinical applications, more studies still need to be conducted.

Primary giant cell tumors of soft tissues (GCT-STs) are extremely rare soft tissue tumors located both in superficial and in deep soft tissues. Clinically, GCT-ST manifests as a slow-growing, well-defined, painless mass. We report a case of an 88-year-old female patient with upper abdominal distension, fever, and anemia. Laparoscopic exploration revealed a tumor located in the left lobe of the liver with localized rupture and hemorrhage. Postoperative pathology revealed that the tumor was composed of monocytes and osteoclast-like multinucleated giant cells, accompanied by extensive hemorrhage, necrosis, and cytologic atypia. Because mitotic cells are difficult to be detected in pathological diagnosis, combined with immunohistochemistry, the tumor was diagnosed as a giant cell tumor of soft tissue. This case report highlights the primary choice of histology and immunohistochemistry for the correct diagnosis of GCT-ST because preoperative radiological diagnosis is nonspecific and prone to mistakes.

Background: Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) represent the predominant histological types of primary liver cancer, comprising over 99% of cases. Given their differing biological behaviors, prognoses, and treatment strategies, accurately differentiating between HCC and ICC is crucial for effective clinical management. Radiomics, an emerging image processing technology, can automatically extract various quantitative image features that may elude the human eye. Reports on the application of ultrasound (US)-based radiomics methods in distinguishing HCC from ICC are limited., Aim: To develop and validate an ultrasomics model to accurately differentiate between HCC and ICC., Methods: In our retrospective study, we included a total of 280 patients who were diagnosed with ICC ( n = 140) and HCC ( n = 140) between 1999 and 2019. These patients were divided into training ( n = 224) and testing ( n = 56) groups for analysis. US images and relevant clinical characteristics were collected. We utilized the XGBoost method to extract and select radiomics features and further employed a random forest algorithm to establish ultrasomics models. We compared the diagnostic performances of these ultrasomics models with that of radiologists., Results: Four distinct ultrasomics models were constructed, with the number of selected features varying between models: 13 features for the US model; 15 for the contrast-enhanced ultrasound (CEUS) model; 13 for the combined US + CEUS model; and 21 for the US + CEUS + clinical data model. The US + CEUS + clinical data model yielded the highest area under the receiver operating characteristic curve (AUC) among all models, achieving an AUC of 0.973 in the validation cohort and 0.971 in the test cohort. This performance exceeded even the most experienced radiologist (AUC = 0.964). The AUC for the US + CEUS model (training cohort AUC = 0.964, test cohort AUC = 0.955) was significantly higher than that of the US model alone (training cohort AUC = 0.822, test cohort AUC = 0.816). This finding underscored the significant benefit of incorporating CEUS information in accurately distinguishing ICC from HCC., Conclusion: We developed a radiomics diagnostic model based on CEUS images capable of quickly distinguishing HCC from ICC, which outperformed experienced radiologists., Competing Interests: Conflict-of-interest statement: We have no financial relationships to disclose., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Abstract Background Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary liver tumor, which has overlapping imaging features with mass forming intra-hepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC). Previous studies reported imaging features more closely resemble ICC and the aim of our study was to examine the differential MRI features of cHCC-CC and ICC with emphasis on enhancement pattern observations of gadolinium enhanced MRI. Methods Institutional review board approval with consent waiver was obtained for this retrospective bi-centric study. Thirty-three patients with pathologically proven cHCC-CC and thirty-eight patients with pathologically proven ICC, who had pre-operative MRI, were identified. MRI images were analyzed for tumor location and size, T1 and T2 signal characteristics, the presence/absence of: cirrhosis, intra-lesional fat, hemorrhage/hemosiderin, scar, capsular retraction, tumor thrombus, biliary dilatation, degree of arterial enhancement, enhancement pattern, pseudocapsule and washout. Associations between MRI features and tumor type were examined using the Fisher’s exact and chi-square tests. Results Strong arterial phase enhancement and the presence of: washout, washout and progression, intra-lesional fat and hemorrhage were all strongly associated with cHCC-CC (P

Primary liver cancer, mainly hepatocellular carcinoma, is one of the most common malignancies worldwide. Surgical management, either resection or transplantation, is considered definitive treatment, however, less than 20% of patients are ultimately candidates. Thermal ablation modalities such as radiofrequency ablation and microwave ablation have evolved such that these modalities have been applied with curative intent. Moreover, thermal ablation has demonstrated efficacy in treating early-stage tumors and can be offered as first-line treatment in patients with uncomplicated disease. Attributing to refinements in technology and techniques, recent studies evaluating stereotactic ablative body radiotherapy have shown promising results, while irreversible electroporation, an emerging modality, may further expand the role of ablative therapy in treating potentially resectable hepatocellular carcinoma. [ABSTRACT FROM AUTHOR]

A 71-year-old man with alcoholic cirrhosis was found to have multiple hypervascular lesions in the liver on enhanced computed tomography. An ultrasound-guided biopsy of the lesion was performed. Immunohistochemical analysis for hepatocyte paraffin 1 expression was negative; cytokeratin (CK) 7, CK19, epithelial cell adhesion molecule and epithelial membrane antigens were positive; mucicarmine staining was negative. The tumor was thus histologically diagnosed as cholangiolocellular carcinoma (CoCC). The tumor was inoperable due to the associated advanced liver disease. In addition, the patient preferred systemic chemotherapy using only orally administered agents. Thus, S-1 monotherapy was recommended. S-1 was initially administered orally at a dose of 80 mg/day. Although the levels of tumor marker (prothrombin induced by vitamin K absence/antagonist-II and carbohydrate antigen 19-9) levels were marginally elevated, their values did not change over the entire course. The patient achieved a partial response according to the Response Evaluation Criteria In Solid Tumors (RECIST) and modified RECIST 1 year after chemotherapy initiation. In conclusion, S-1 monotherapy exhibited promising efficacy against unresectable CoCC. [ABSTRACT FROM AUTHOR]

The fastest growing cause of cancer-related death is hepatocellular carcinoma (HCC), which is at least partly attributable to the rising prevalence of non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease (NAFLD) encompasses a broad spectrum of conditions, ranging from non-progressive bland steatosis to malignant transformation into hepatocellular cancer. The estimated annual HCC incidence in the progressive form of NAFLD – non-alcoholic steatohepatitis (NASH) – is about 0.3%. The risk of HCC development is higher in men and increases with age, more advanced fibrosis, progressive obesity, insulin resistance and diabetes mellitus. Studies on the molecular mechanism of HCC development in NAFLD have shown that hepatocarcinogenesis is associated with complex changes at the immunometabolic interface. In line with these clinical risk factors, administration of a choline-deficient high-fat diet to mice over a prolonged period results in spontaneous HCC development in a high percentage of animals. The role of altered insulin signaling in tumorigenesis is further supported by the observation that components of the insulin-signaling cascade are frequently mutated in hepatocellular cancer cells. These changes further enhance insulin-mediated growth and cell division of hepatocytes. Furthermore, studies investigating nuclear factor kappa B (NF-κB) signaling and HCC development allowed dissection of the complex links between inflammation and carcinogenesis. To conclude, NAFLD reflects an important risk factor for HCC, develops also in non-cirrhotic livers and is a prototypic cancer involving inflammatory and metabolic pathways. Strengths/weaknesses and summary of the translational potential of the messages in the paper The systematic review summarizes findings from unbiased clinical and translational studies on hepatocellular cancer in non-alcoholic fatty liver disease. This provides a concise overview on the epidemiology, risk factors and molecular pathogenesis of the NAFL-NASH-HCC sequence. One limitation in the field is that few HCC studies stratify patients by underlying etiology, although the etiology of the underlying liver disease is an important co-determinant of clinical disease course and molecular pathogenesis. Molecular profiling of NAFL and associated HCC holds great translational potential for individualized surveillance, prevention and therapy. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is a major primary liver malignancy in adults. Despite the progress made, the outcome of the treatment to this disease is less than satisfactory as the post therapy tumor recurrence is almost inevitable. Accumulating pieces of evidence have suggested that the recurrence is due to the existence of a subpopulation of the HCC cells that possess the properties of stem cells and are resistant to radiation and chemotherapy. It is therefore important to understand the characteristics of this subpopulation of HCC cells, and which requires the establishment of an in vitro system to study these stem-like cancer cells. However, despite extensive efforts, the progress in establishing such an in vitro system has been slow largely due to the lack of definitive biomarkers in the isolation and expansion of these cells. In order to successfully maintain and expand HCC CSCs, we first optimized the culture system. We establish a novel medium system that allows the culture and enrichment of these hepatic stem-like cancer cells from both hepatoma cells and human primary HCC cells. These cells exhibited typical stem cell properties, such as enhanced stem cell markers, gain of EMT properties and drug resistance, and more importantly, stronger tumor-initiating capabilities. The medium may help to establish an in vitro model for hepatic cancer stem cell (HCSC) studies, which may contribute to the development of novel cell therapies and new drugs for the treatment of HCC. [ABSTRACT FROM AUTHOR]

Purpose: To determine MR features suggestive of mass-forming cholangiocarcinoma (CCA) or liver metastases of adenocarcinoma of unknown primary (AUP), and to compare the ability of two experienced radiologists to establish the correct diagnosis. Materials and methods: 61 patients with CCA or AUP, with MRIs were placed into two groups: population 1, 28 patients with certain diagnosis of either CCA or AUP; and population 2, 33 patients with uncertain diagnosis. Using population 1 with known diagnosis, two investigators formulated imaging criteria for CCA or AUP, which represented phase 1 of the study. In phase 2, two independent radiologists categorized the patients in populations 1 and 2 as CCA or AUP using the formulated criteria. This categorization was compared with the patient medical records and pathologist review. Findings were tested for statistical significance. Results: In phase 1, solitary lesion, multifocal lesions with dominant lesion, capsule retraction, and porta hepatis lymphadenopathy were features of CCA; multifocal lesions with similar size, and ring enhancement were features of AUP. The number of lesions, capsule retraction, and early tumor enhancement pattern were observed to be significant features ( P < 0.05). In phase 2, agreement between the two radiologists was good ( k = 0.663). For population 1, the agreement was good ( k = 0.659), and was fair for population 2 ( k = 0.293). Concordance between the two radiologists, medical record, and the pathologist was found in 41/61 (67%) patients. Conclusion: Distinctive features of CCA and AUP are identifiable on MRI images, which may aid the radiologist to establish the correct diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: To describe the magnetic resonance imaging (MRI) appearance of hepatic combined hepatocellularcholangiocarcinoma (cHCC-CC) in 11 patients. Materials and Methods: The database of the Department of Pathology was cross-referenced with the MRI database to identify patients with confirmed cHCC-CC who had undergone MRI. Eleven consecutive patients were included (seven female, mean age 57.6 years). All patients were Caucasian. Five of 11 had a clinical history of chronic liver disease. Two radiologists retrospectively analyzed the images in consensus. Results: cHCC-CC was a single mass in 10/11 patients. Margins were well-defined in 6/11. All tumors showed heterogeneous hyperintensity on T2. On postcontrast imaging, 6/11 showed early ring-enhancement (four noncirrhotic), with progressive enhancement in central portions, and 5/11 patients showed a diffuse heterogeneous early enhancement. Three of these five were cirrhotic and displayed partial washout with portions of contrast retention on later phases. Other findings included: late capsule enhancement (two patients), biliary dilatation (one), venous invasion (three), lymphadenopathy (six), and findings of cirrhosis (five). Conclusion: cHCC-CC presents most commonly as a single mass. Five of 11 had MR findings of cirrhosis. Clues to the diagnosis were moderately high signal on T2, portions of tumor that show progressive enhancement/ contrast retention, and frequent lack of capsule. Early enhancement patterns included early ring-enhancement and diffuse heterogeneous enhancement. [ABSTRACT FROM AUTHOR]

The article presents a study which tested the proposal that attributed a unique pathologic tumor-node-metastasis (pTNM) staging to intrahepatic cholangiocarcinoma (IHCC). The researchers have shown that the 7th edition of the staging manual maximizes the clinical relevance and predictability of outcomes. They recommend that hepato-pancreato-biliary (HPB) surgeons get the habit of sampling lymph node (LN) routinely at the time of surgery to ensure accuracy.

Summary: Inherited multitumoral syndromes including colorectal carcinoma are the followings: familial adenomatous polyposis (FAP), hereditary non-polyposis colon cancer (HNPCC) and Peutz–Jeghers syndrome (PJS). The studies of genotype–phenotype correlation have shown that various types of colonic polyposis are related with germline mutation of adenomatous polyposis coli (APC) gene, that is also responsible for a wide number of extracolonic manifestations. Concerning severity of polyposis, it has been suggested to perform ileorectal anastomosis in patients with intermediate FAP, whereas it has been suggested to remove the rectum from the beginning and to perform ileopouch anastomosis in patients with severe FAP (germline APC mutations between codons 1250 and 1464, i.e. mutation cluster region—MCR). Concerning extracolonic manifestations, original studies from our laboratory have shown that three peculiar, even if unusual extracolonic manifestations of FAP, were in the 5′ portion of the gene, but almost always outside of MCR. In particular, in some patients or in some kindreds all these manifestations may be present together. It is suggested, from one hand, because of the wide variety of genotype–phenotype correlation word of caution before selecting surgical treatment simply on the basis of the germline mutations, on the other hand co-segregation of some extracolonic manifestations could facilitate intensive screening, early diagnosis and optimal time for treatment. [Copyright &y& Elsevier]

Abstract: Adenosquamous cell carcinoma is characterized by both squamous and glandular components, and is a rare disease of the liver that is the subject of few reports in the literature. We present a case in which the imaging findings on CT, MRI, and hepatic arteriography, as well as pathological correlation of the tumor and the clinical history, aided in including this entity in the differential diagnosis. [Copyright &y& Elsevier]

Introduction and Aims: Primary liver cancer is a public health problem in Mexico and the world. Liver transplantation (LT) is the ideal treatment for early hepatocellular carcinoma (HCC). Our aim was to evaluate the characteristics of patients with HCC and cholangiocarcinoma (CC) at two centers and identify transplantation candidates., Materials and Methods: A retrospective observational study was conducted at the Hepatology Center (HC) and the University Center Against Cancer (UCAC), within the time frame of 2012-2018. HCC or intrahepatic CC was confirmed in 109 patients. Staging classifications, transplant selection models, and a predictive model for post-LT recurrence were applied to the HCC patients., Results: Of the total population, 93% (n=102) presented with cirrhosis, 86% (n=94) had HCC (HC: 58%, UCAC: 42%), and 14% (n=15) had intrahepatic CC (HC: 40%, UCAC: 60%). Of the HC patients with HCC, Okuda I-II, BCLC A-B, and AFP levels <100ng/m predominated, whereas Okuda II-III, BCLC C-D, and AFP levels >1000ng/mL predominated in the UCAC patients. Half of the HC population with HCC met the criteria for LT, in contrast to 23% of the UCAC patients. Fifteen patients were evaluated for LT, and at present, six have undergone transplantation., Conclusions: The most frequent primary liver tumor was HCC. Patients from the HC presented with earlier-stage disease and a high number of them met the criteria for LT. Only patients from the HC underwent transplantation., (Copyright © 2021. Published by Masson Doyma México S.A.)

Primary adenosquamous carcinoma of the liver is a rare subtype of cholangiocarcinoma. Adenosquamous carcinoma, which consists of both adenocarcinoma and squamous cell carcinoma components. A 73-year-old woman was admitted to our hospital with a 1-year history of anorexia and general fatigue. Abdominal computed tomography (CT) disclosed a mass, 8 cm in diameter, with low-density located and central necrosis in the right lobe segment of the liver. Because of the rapid development of the liver tumor, the patient died of liver failure 10 months after the surgery.

Aim: To evaluate survival and toxicity in a cohort of patients treated with stereotactic body radiation therapy (SBRT) for unresectable intrahepatic malignancies., Patients and Methods: From 2007 to 2014, 23 patients with 34 lesions (three primary and 31 metastatic liver tumors) were treated with SBRT., Results: The median follow-up was 9 months (range=1-76) for all patients. Local control was reached in 27 out of 34 (79%) treated lesions, with 1 and 2 years rates of 93% and 73%, respectively. The progression-free survival at 1-year and 2-year was 50% and 25%, respectively. Median overall survival was 16 months (95% confidence interval=8-24 months), with 1-year and 2-year rates of 58% and 41%, respectively. Toxicity was very low consisting mainly of grade 1 and 2 events., Conclusion: SBRT provides good local control for both primary and metastatic liver lesions, with minimal toxicity., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)